Provider Demographics
NPI:1225561400
Name:WASHINGTON, EUGENIA ELIZABETH
Entity Type:Individual
Prefix:
First Name:EUGENIA
Middle Name:ELIZABETH
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8623 N WAYNE RD STE 310
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-1137
Mailing Address - Country:US
Mailing Address - Phone:734-425-0636
Mailing Address - Fax:734-425-4771
Practice Address - Street 1:8623 N WAYNE RD STE 310
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-1137
Practice Address - Country:US
Practice Address - Phone:734-596-0773
Practice Address - Fax:734-425-4771
Is Sole Proprietor?:No
Enumeration Date:2017-04-05
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401016386101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional